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•TE RECEIVED • SAN JOAQUIN COUNTY tHV LUV NUMUCK_ <br /> ENVIRONMENTAL HEALTH DEPARTMFNT <br /> y? 1 }{ Uu3 304 E Weber Ave 3'a Floor Stockton, CA 95205 I <br /> (209)468-3420 Fax: (209) 464-0138 Web: www-co.san-joaquin-ca us/ehd <br /> PUBLIC RECORDS RELEASE'�APPLICATION <br /> j� <br /> APPLICANT. S BUSINES(SIAGENCY:�iLLnnr� 6re0 L�l1U�YDn111� <br /> ADDRESS: 937 �/a/w <br /> PHONE: a / � <br /> O9. / ( 00�- FACSIMILE: u O �� • //�" ��,,��yy�� <br /> TENTATIVE'APPOINTMENT DATE: �I •J —Time:�oy <br /> (please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 SUSINE n. / <br /> SIGNATURE OF APPLICANT ent Use Only <br /> FILE ADDRESS UNIT <br /> TM - cl ❑ Unit 1 C <br /> t m G <br /> z ��' _ ❑ Unit <br /> 3. SVeet I <br /> a. Saw i Unit <br /> 5. ske C <br /> e, SVesl G .a i�Q Unit 4 <br /> 7. 6ac=t V <br /> W <br /> e. 6vem OR Unit 5 <br /> 9, SVael CI <br /> 10. Syed I <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ HOUSING ABATEMENT CI WASTE FACILITY <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> L� OTHER CLEANUP SITE(NON-LOP) 13DAIRY <br /> "7j UNDERGROUND TANK(MONR ❑ DOG KENNEL <br /> ORINGIREMOVAL) ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR [3MOTELIHOTEL ❑ PUMPER TRUCKIYAROICHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY ❑ PDOIJSPA in LAND USE APPLICATION SITES <br /> U1 TATTOO/BODY PIERCING L1 OTHER(PLEASE SPECIFY) <br /> O MEDICAL WASTE FACILITY <br /> List up to ten addresses in the space above. Select the types) of tiles from the list above by checking <br /> 1. type UST be selected. Fax to (209)464-0138 or mail to the <br /> the appropriate box(es). At least one p M <br /> address indicated above. ointment for review will be Confirmed <br /> 2. EHD will notify the applicant if any EHD files exist. to app <br /> approximately five business days but no later than tan (10) days after receipt <br /> should pbe scheduled <br /> edfiles <br /> will be held for a maximum Of five business days for review. Appointments <br /> accordingly. <br /> 3, A file that is actively being worked on by EHD staff may not be immediately available for review. new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will b®reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. ■ <br /> 6. Applications received after 3:00 pm will be processed the next business day. rf <br /> TIME <br /> CONFIRMED APPOINTMENT DATE INITIALS <br /> DATE CONFIRMED PHONE <br /> REVIEWED <br /> YES NO REVIEW DATE <br /> EHD 464240 <br /> eienaas <br /> 10/10 39Vd NOJADOJS 30V 8TTTL9b60L 0T:d1 £00L/8T/80 <br />